title: [Association of nutrition with treatment compliance and toxicities in patients undergoing chemoradiation after gastrectomy].
abstract: OBJECTIVE
  To investigate the association of nutritional status with treatment compliance and toxicities in patients undergoing chemoradiation therapy (CRT) after gastrectomy.
  
  
  METHODS
  From September 2010 to May 2012, 40 patients with gastric cancer received adjuvant CRT in the Department of Radiation, Shanghai Cancer Center. Data including clinical data, weight loss of perioperative period, dynamic changes of weight, NRS 2002 score, PG-SGA score, lymph cell count and serum albumin during CRT, toxic effects and nutritional interventions were collected. Treatment compliance of CRT and adjuvant chemotherapy was recorded. Associations among nutrition, toxicities and treatment compliance were statistically studied.
  
  
  RESULTS
  Weight loss percentage from pre-operation to pre-CRT(T1-T2) was 10.0%, which was significantly higher than that of 4.3% during CRT(T3) (P<0.05). Adverse reaction incidence of digestive tract during T3 was 95.0% (38/40). Patients with weight loss >5% during T3 had higher ratio of >II degree digestive tract adverse reaction [91.3% (21/23) vs. 76.5% (13/17), P<0.01] and higher ratio of >3 symptoms of digestive tract[82.4% (14/17) vs. 39.1% (9/23), P<0.05] as compared to those with weight loss ≤5% during T3. Fourteen patients (35.0%) did not complete the synchronous CRT. Factors related to incompletion of CRT were weight loss >7% after surgery (T1) or >10% during T1-T2, malnourishment before CRT, dependence on nutritional support during CRT. Factors related to incompletion of adjuvant chemotherapy were weight loss >5% during CRT(T3), requirement for nutritional support and NRS 2002 score ≥5 at the end of radiation (all P<0.05).
  
  
  CONCLUSIONS
  Nutritional deterioration before CRT may aggravate the toxicities and reduce compliance of CRT in patients with radical resection of gastric cancer. Malnutrition during CRT may impair compliance to adjuvant chemotherapy. Therefore, early and persistent nutritional interventions are crucial considerations of strategies of multidisciplinary treatment for patients with gastric cancer.
authors.affiliation: Department of Radiation Oncology, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, China. zhenzhang6@gmail.com.
authors.forename: Qi-wen
authors.initials: QW
authors.lastname: Li
authors.forename: Gui-chao
authors.initials: GC
authors.lastname: Li
authors.forename: Ya-nong
authors.initials: YN
authors.lastname: Wang
authors.forename: Zi-wen
authors.initials: ZW
authors.lastname: Long
authors.forename: Xiao-wen
authors.initials: XW
authors.lastname: Liu
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*